Managing substance abuse on psychiatric units: a scoping review

Area of Science:

• Psychiatry
• Addiction Medicine
• Healthcare Management

Background:

• Substance use during psychiatric hospitalization poses risks to patient safety and treatment continuity.
• Limited practical guidance exists for ward staff managing on-unit substance use.
• Effective strategies are needed to address alcohol and drug use within inpatient psychiatric settings.

Purpose of the Study:

• To conduct a scoping review of peer-reviewed literature on detecting, managing, and responding to substance use in psychiatric inpatient units.
• To summarize the effectiveness and scope of reported strategies for managing inpatient substance use.

Main Methods:

• The review followed the PRISMA-ScR framework, searching multiple databases (PubMed, Embase, PsycINFO, Google Scholar) up to April 2025.
• Included English- and French-language empirical studies, quality-improvement reports, policy evaluations, and scoping reviews describing inpatient interventions.
• Data extraction and critical appraisal were performed using standardized tools, with 18 studies meeting inclusion criteria.

Main Results:

• Seven intervention domains were identified: screening, brief motivational interventions, policy development, environmental/security measures, harm reduction, staff training, and discharge planning.
• Structured screening doubled detection rates; brief interventions (e.g., SBIRT, BIMI) improved post-discharge engagement and reduced readmissions by up to 18%.
• Zero-tolerance security measures had inconsistent effects, and overall evidence quality was moderate, often from single-site studies.

Conclusions:

• Standardized screening, ward-adapted brief interventions, patient-centered policies, and harm reduction are feasible and effective for managing inpatient substance use.
• Punitive security tactics alone are insufficient; research gaps exist in multi-site evaluations and diverse clinical settings.
• Further research is needed on integrated harm reduction for non-nicotine substances and in adolescent/forensic populations.